Seda Banu AKINCI, Fatma SARICAOĞLU, Saadet ÖZGEN, Ülkü AYPAR

Anestetik ajanların postoperatif üriner retansiyon üzerine etkileri

Protez ameliyatlarından sonra kateterizasyon nedeniyle bakteriüri ve üriner enfeksiyon (%9-16) geliştiği bilinmektedir. Üriner sistem enfeksiyonları ise, protez sonrası derin yumuşak doku enfeksiyonları ile doğrudan ilişkilidir. Değişik anestezi yöntemlerinin ve analjeziklerin postoperatif üriner retansiyonunu etkileyebilecek faktörler oldukları bildirilmiştir. Bu prospektif ve randomize çalışmanın amacı, propofol infüzyon, sevofluran ve halotan inhalasyon anestezilerinden sonra postoperatif üriner retansiyon insidansının karşılaştırmaktır. Etik kurul izni alındıktan sonra, total kalça protezi ameliyatı yapılacak 63 hasta anestezi idamesinde rasgele olarak üç gruba ayrıldı. Olgulara azot protoksit ile birlikte propofol infüzyonu (Grup l), sevofluran (Grup II) veya halotan (Grup III) anestezisi uygulandı. Tüm olgularda hasta kontrollü analjezi cihazı ile meperidin infüzyonu verilerek postoperatif analjezi sağlandı. Perioperatif uygulanan ilaçlar, verilen sıvı, kolloid, kan miktarları, kanama miktarı, operasyon süresi, postoperatif ağrı düzeyleri, analjezik kullanımı, üriner retansiyon, üriner sistem enfeksiyonları kaydedildi. Gruplar arasında yaş, cinsiyet, preoperatif üriner sistemle ilgili şikayetler, anestezi süreleri, sıvı replasmanı, idrar yolu enfeksiyonları, preoperatif ve postoperatif laboratuvar değerleri açısından fark yoktu. Postoperatif birinci günde idrar retansiyonu halotan grubunda (%43), propofol grubuna (%14) ve sevofluran grubuna (%19) göre anlamlı olarak daha yüksek olarak bulundu. Sonuç olarak, anestezi idamesinde halotan kullanılmasının total kalça protezi ameliyatları sonrasında postoperatif birinci günde üriner retansiyonu artırdığını saptadık. Özelikle postoperatif üriner retansiyon açısından riskli hastalarda halotan yerine sevofluran ya da propofol infüzyon anestezilerinin kullanılmasının daha uygun olacağı kanısındayız.

Anahtar Kelimeler:

Artroplasti, replasman, kalça, Anestezikler, inhalasyon, Anestezi, genel, Propofol, Halotan, Anestezikler, Üriner retansiyon

The effects of anesthetic agents on postoperative urinary retention

It is known that urinary infections and bacteriauria may occur by urinary catheterization after arthroplasty operations. Urinary system infections have direct effect on soft tissue infections. It is reported that different anesthesia techniques and postoperative analgesics may effect urinary retention. The aim of this prospective randomized study was to compare the incidence of urinary retention after propofol infusion, sevoflurane and halothane anesthesia. After obtaining ethical committee approval, 63 patients, scheduled to undergo total hip replacement were randomized into three groups. Patients received either propofol infusion and nitrous oxide (Group I) or sevoflurane and nitrous oxide (Group II) or halothane and nitrous oxide (Group III) for anesthesia maintenance. Postoperatively, all patients received patient controlled analgesia with intravenous meperidine. Perioperative drugs, fluids, colloids, blood products, blood loss, duration of operation, postoperative pain scores, analgesic use, urinary retention, and urinary infection were recorded. There were no differences among the groups in terms of age, gender, preoperative urinary symptoms, duration of anesthesia, intraoperative fluid balance, urinary tract infection, preoperative and postoperative laboratory values. On the first postoperative day, urinary retention in the halothane group (43%) was significantly higher than the propofol (14%) and the sevoflurane (19%) groups. As a result, we found that use of halothane for anesthesia maintenance caused an increase in the incidence of urinary retention on the first postoperative day after total hip replacement. We concluded that, propofol infusion or sevoflurane would be better for anesthesia maintenance in stead of halothane especially in patients at high risk for postoperative urinary retention.

Keywords:

Arthroplasty, Replacement, Hip, Anesthetics, Inhalation, Anesthesia, General, Propofol, Halothane, Anesthetics, Urinary Retention,

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